Frequency and management of urological and some other complications following radical surgery for carcinoma of the cervix uteri, stages I and II. A series of 202 patients with stage I and II carcinoma of the cervix uteri is presented. Radical hysterectomy and pelvic lymph node dissection was performed in all cases and most patients received radiotherapy in addition. The condition at 5-year follow-up of all patients is reported and the facts associated with operative complications are analysed. Special attention was paid to the urological condition by performing urographies as a routine study both pre- and postoperatively. There was a strong correlation between the pathological postoperative urologic finding in regard to poor prognosis and permanent complications. Urinary tract infections occurred frequently and were difficult to handle. The operations performed for urological complications are listed. It is concluded that the treatment of carcinoma of the cervix uteri should be concentrated on clinics with a well-trained staff. At every stage of treatment intensive teamwork is most important. The rate of complications can be reduced by intensifying studies especially in the postoperative period. New diagnostic procedures and prophylactic measures should be tried andintroduced into routine practice if proved valuable. It is important that major surgery, such as radical hysterectomy, be performed in a teaching hospital for gynecologists.


Hyperparathyroidism and pregnancy. Report of a case and review of the literature. A 28-year-old gravida III, with a history of two unsuccessful pregnancies, was admitted with hyperemesis gravidarum and was found to be suffering from hyperparathyroidism (HPT). She was treated surgically and was later delivered of a wellformed, premature girl. The literature is reviewed and the histories of 40 females (including the patient of this case report) with a minimum of 93 pregnancies while suffering from HPT shows, that HPT during pregnancy is a serious condition for the fetus as well as for the mother. There was an increased incidence of spontaneous abortion, perinatal death, premature birth and neonatal morbidity. The mothers suffered from increased episodes of renal calculi and hyperemesis gravidarum. The exacerbations nearly always occurred in the first and second trimesters or post partum.


Tubal pregnancy treated by salpingectomy using operative culdoscopy. A case of unruptured Ampullary pregnancy in the 7th postmenstrual week is presented, which was diagnosed and treated at the same time by operative culdoscopy. The indication and advantages of this method are discussed.


Diffuse vaginal adenosis. Three cases combined with imperforate hymen and haematocolpos. Diffuse vaginal adenosis is a rare disease presenting severe symptoms and difficult to treat. It has not previously been described in the Scandinavian literature. Three typical cases are reported, two in children of 14 years and one in a women of 20 years, who were all treated for imperforate hymen and haematocolpos. None of the patients had been subjected to oestrogen treatment in utero. The colposcopic findings are very characteristic and are described in relation to the histological examination. The pathogenesis, treatment and risk of malignant transformation are discussed.


[University crisis and student psychiatric service]. This paper briefs a research on the influence of stressing environmental factors upon mental health conditions of university students. The study was undertaken at the Student Psychiatric Service, Universidad del Valle, Cali, Colombia. Three equal periods are compared. The first is a normal one; the others are disorderly and riotous, up to the point of foreing the discontinuance of academic activities for several months. As compared with the period of academic stability, the rates of mental disturbances show a steep rise in the periods of agitation. Schizophrenia, depression, anxiety, all kinds of difficulties in interpersonal relations, and somatic disturbances, are sharply increased, whereas complaints of less severe disturbances, like transient situational disorders, level up or decrease. Another significant rise is registered in the use of drugs for therapeutic purposes. The study leads to the conclusion that stress due to environmental disorders or social upheavals is an important factor in the aethiology of severe mental disturbances.


[The method of personal interaction laboratories applied to groups of married couples]. The aim of Personal Interaction Laboratories is not to overcome or to solve any marriage problem or maladjustment. They provide an intense, quick experience, in which the participants get a rare chance to examine the way they are interacting with each other's partner, and the degree of mutual adaptation. A peculiar atmosphere of trust and reliability is usually created in the group, and grows steadily according to the increasing willingness of all members to share a higher degree of intimacy. This climate allows for deep emotional exchanges through which persons and couples gain a fresh view of themselves, allowing a long lasting drive for improving their life patterns. This report briefs the results of four Laboratories for married couples sponsored by the Human Welfare Foundation ("Fundación para el Bienestar Humano"), at Medellín-Colombia, in 1971 and 1972; they included 8, 10, 6 and 12 couples, that is, 36 in all. Participation in the Laboratories was set on a strictly voluntary basis; information was provided to personnel of the main industrial and commercial corporations, and interested prospective candidates applied for admission. The couples were selected according to their socio-economical level (medium and lower-medium), their educational background (at least two years of high school), and their lack of apparent mental symptoms. A special country resort was selected for the Laboratories, in order to guarantee adequate isolation for the group and no possible contacts with the familiar environment. Sessions were started on Wednesdays at 8 pm and closed on Sundays at 1.30 pm. The available time was completely devoted to Laboratory activities, allowing only short breaks for meals. T-group sessions took most of the time. They were given special attention, being at the core of group development. Each session was 90 to 120 minutes long; a total of nine were programmed. There were complementary activities, such as lectures on marriage counseling, group discussions on texts previously studied, role-playing on specific familiar situations, and related subjects. The participants were also to complete several forms: before, during and after the experience, the last one being delivered several months later.


[Behavior therapy. Bases and criticism]. Our first concern is a general characterization of behaviour therapy. It cannot be produced by means of the description of its methods and techniques, since it includes a wide gamut of them, ranging from systematic desensitization to assertive training and aversive conditioning. It is necessary then to resort to the theoretical basis common to the different methods and techniques. The reciprocal inhibition principle, as stated by John Wolpe, is likely to provide a sound starting point. To Wolpe's mind, a neurosis is an anxiety response deeply rooted through conditioning. Most behaviour therapists share this conception. The therapist task is, according to it, to unchain the circuit between anxiety producing stimulus and neurotic responses. In order to achieve the disjunction, an antagonistic response is used, that reciprocally inhibits the anxiety response. Systematic desensitization based on relation is a typical application of the reciprocal inhibition principle. Nevertheless, other usual techniques, such as negative practice (used by Yates for the treatment of tics) or Skinner's operant conditioning are not based on that principle. A wider basis is thus required. Behaviour therapists claim that the theoretical basis is to be found in learning theory laws. The reciprocal inhibition principle is the counterpart of the counter-conditioning law, the negative practice principle is similar to the extinction law, and so on. However, there is not one single learning theory, but several ones, mutually contradictory. And they are not fit to provide the needed theoretical basis. That disagreement can be overcome looking for the common principle of all learning laws, namely, that the need is to create definite circuits that can operate in front of adequate stimulus. Still another set of criticisms to behaviour therapy comes from dynamic psychology and psychoanalysis. The fact is stressed that suppressing symptoms does not modify structural maladjustments. Behavior therapists acknowledge their treatments are kept at symptom level, but they claim it is the right approach, since the symptom is the neurosis, according to their conceptions.


[Current status of the clinical evaluation of psychotropic drugs]. This paper deals with the analysis of different research conceptions and designs, according to different areas: I. Human Pharmacology and Toxicology; II. Therapeutic prescriptions; III. Therapeutic effects; IV. Thorough clinical testing. There is a strongly felt -eed of universally acknowledged rating scales for the assessment of the effects psychothropic drugs have on mental diseases. The lack of experimental models, together with the wide span of psychodinamic conceptions, overemphasizes the need of such an instrument for evaluative purposes. A review is made of Patient Data Inventories, Side Effects Detection, Overall and Gorham Psychiatric Scales, Hamilton Depression Scale, Zung Self-Testing Scale, Wittenborn Psychiatric Scale, Eysenck Personality Inventory, Taylor Anxiety Scale, Hamilton Anxiety Scale, Beck Depression Scale, the "100 mm" Test and "d2" Test. Some remarks are made on the usefulness of non-parametrical statistical techniques in comparison with parametrical ones, requiring a normal distribution of frequencies and being unfit to operate in case of nominal and ordinal scales. The author emphasizes the need to avoid automatic translation of results pertaining to one population into another different one. Likewise, standardized classification scales obtained by the physician through interviews should be linked to self-evaluation scales simultaneously used by patients.


[Combination of tricyclic antidepressants and MAOI in the depressions]. This study was aimed at the assessment of therapeutic and side effects of simultaneous administration of tricyclic antidepressants and MAOI. The sample consisted of 122 patients with depressive syndromes, treated at the "Centro de Psicología Médica San Martín de Tours" (period 1970/1973), with Isocarboxazide and Trimiprimine. All patients received both drugs three times a day. The average daily dose was 20 mg of Isocarboxazide together with 125 mg of Trimiprimine. The average treatment was 70 days long. The study lead to the following conclusions: 1. There were no serious side effects. 2. The scarce side effects registered were not very different from those of the other anti-depressants. 3. The therapeutic doses were lower than those required when each drug is used alone. 4. The speed of action was higher than for each drug separately. 5. The overall percentage of improvement in patients was higher than the percentage obtained for each drug alone. 6. The lack of side effects for a theoretically risky combination of drugs is likely to be attributed to the neuroleptic action of Trimipramine.


[The being ill of the schizophrenic approached from existential analysis]. Schizophrenia is one of the most pervading and obscure mental deseases. No scientific explanation--either somatogenic or psychogenetic--has attained, so far, a comprehensive grasp of schizophrenic ways of experiencing the world. Not that the valuable research made in many branches of Psychiatry is to be belittled because of being parcial or single-oriented: it is necessary a completely different approach--from a phenomenological standpoint-- provided by Daseinanalyse, to encompass the richess and complexity of schizophrenic experience. In that view, "being-ill" is, for the schizophrenic, a basic impairment of the capacity of "being-open-to" the human environment, and a correlative lack of "feeling-of-the-self", an incapability to be what one really is. The consequence is a loss of freedom, a basic difficulty to face the world and to reach its meaning together with the meaning of one's own life. Three cases are discussed, in which the patients are overwhelmed by other's actions and thoughts, and cannot tell apart what pertains really to their own inner world. They are even absorbed by inanimate elements, or by ordinary objects of everyday life. Everything is a threat to their nonexisting beings. Once such a grasp of the complexities of schizophrenic "way-of-being-in-the-world" is attained, it is possible to work towards the development of the patient's own self, to help to expand and strenghthen the individual inner "roots" in order to gain a higher level of individual entity that enables the patient to face the world without the risks and perils of being engulfed in its maelstroms.


[General considerations on psychiatric interconsultation]. This paper attempts to follow the evolution of some general ideas on Psychiatric Interconsulting. It is the result of six years' work at Ramos Mejía Hospital, Buenos Aires. Progressive transformations were imposed by daily practice on our team's theoretical and technical conceptions. We started with an individualistic-phenomenical approach, and we were forced to switch to a dynamical-situational one. The general working model we use at present is briefly summarized, emphasizing the important role played by Psychiatric Interconsulting in the change of the medical cultural patterns prevailing at present in our milieu. Two main factors for the role of privilege played by the Interconsulting team are set forth: one is conceptual, the other is pragmatic. From a conceptual standpoint, the theoretical basis of Psychiatric Interconsulting is much broader than those of other specialities, like clinical practice or surgery, for it includes, besides Biology, the Psychological and Socio-Historical determinants of the disturbance the diseases man suffers. From a pragmatic standpoint, the boundaries of human and physical fields within which Psychiatric Interconsulting is operating, go beyond the scope of daily medical practice. Their place could be located in between formal traditional wefts, relating to institutional structures as well as to specific medical practice. Professionals working at Interconsulting are usually required at general wards, at consulting offices, at emergency wards, in corridors, or even at the bar. They are interested not only in specific medical problems; they encompass the whole range of personal and institutional framework, and consider the whole situation in a comprehensive approach. Knowledge acquired in this widened professional field, together with actual experience in dealing with people in distress, are the main sources for theoretical conceptualization of new activities, as well as for building pragmatic tools to modify the official medical model of thinking.


[Nosography in child psychiatry].

[Nosography in child psychiatry]. There is an important jeopardizing factor for all nosological classificatory systems, in general Psychiatry as well as in child Psychiatry: the lack of a universally valid basis for defining concepts of "normal" and "pathological". Both stem from social patterns, values, culture and organization. Thus, they vary widely in different countries and communities. In order to attain the much needed general nosological criteria, the starting point is to our mind, a scientific comprehensive conception of man in the midst of a social environment. Pathological phenomena are usually located either in biological, psychological or sociological domains, but they are all-pervading and affect man in the whole. Taking into account that the same can be said about children, we discuss in this paper one classificatory system proposed by Telma Reca M. D. and modified by the author. Following the gravitation of the main aethiological factors, four categories are proposed: a. Psychogenetical diseases: regular or reactive developmental disturbances; acute anxiety; neurotic traits; fully developed neurosis, and psychosomatic disturbances of neurotic origin; speech disturbances of a pure psychological nature, etc. b. Psychical disorders derived from physical diseases: acute confusional or delusional states; mental retardation; epilepsy; minimal cerebral disfunction; learning difficulties derived from injuries or/and genetic deficiencies, etc. c. Psychical disorders derived from social problems: bad nourishment, disturbed sleep, faulty or disorderly sexual behaviour; poor or disturbed performance at school or in social groups, etc. d. Disorders caused by several factors: psychotic traits; psychosis; psychopathic behaviour; lack of maturity according to chronological age; congenital personality disorders, etc.


11C and 15O induced in the mouse by 175 MeV protons. The total production of 11C, 13N and 15O in the mouse by protons with a mean energy of about 175 MeV was found to be 8 200, 1 500 and 14 000 nuclei per g-rad, respectively. About 40 per cent of the total induced 11C activity was eliminated through expiration and about 2.5 per cent with the urine during the first hour after irradiation. The expired gas contained 11CO and 11CO2 in the ratio 2/1. The urinary 11C activity was bound to several compounds, the chemical nature of which was not established. The 15O activity behaved as H2O and was found not to be eliminated from the body during the short observation time available. The additional, fractional, integral radiation dose due to decay of induced nuclides is less than 0.1 per cent, and can be neglected since no accumulation to any small organ was seen. Sensitive means for an estimate of integral dose based on the induced nuclides would be the detection of 11CO activity in expired gas or in blood.


Capacity of sera from patients with mammary carcinoma to promote PHA-stimulation of human lymphocytes. Lymphocytes from patients with carcinoma have been reported to exhibit impaired immunologic reactivity and responsiveness to non-specific stimuli both in vivo and in vitro due to inhibitory serum factors. In the present investigation it is tested whether sera from patients with mammary carcinoma may inhibit the response of lymphocytes from normal donors to phytohaemagglutinin (PHA) in vitro. Neither sera from patients with newly diagnosed breast malignancy nor patients with wide spread disease differed from control patients with benign breast lesions. Serum activity did not change within 3 weeks after radical mastectomy or local irradiation but increased slightly after 6 weeks. It is suggested that the impaired PHA-responsiveness of lymphocytes in patients with mammary carcinoma is not due to blocking serum factors but to intrinsic cellular abnormality.


Objective symmetry detector method for gammaencephalography. II. Normal range. A standardized clinical examination procedure of a previously described symmetry detector method for gammaencephalography is presented and the results obtained from a reference group of subjects without known neurologic disorders are reported. The 99TcmO4 distribution in the skull was investigated by 208 evaluation parameters obtained from measurements of 24 subregions of the skull from 48 symmetrical positions. Mean values and associated inter-individual and intra-individual standard deviations are given. Different sources of variation are discussed in relation to the results obtained. The method enables the 99TcmO4 distribution in the skull to be objectively classified as normal or abnormal.


Histologic and histochemical reactions in a mouse mammary carcinoma following exposure to combined heat-roentgen irradiation. In mouse experiments a high curative effect on implanted tumours was obtained by successive application of low local heat and roentgen doses. Histologic and histochemical examinations of tumours so treated revealed a special reaction in the tissues. A total and rapid destruction of all hypoxic tumour tissue was observed and (in successful cases) a total blockade of all mitotic activity in euoxic tumour tissue was followed by a long-drawn necrobiotic decay of the existent tumour cells. The disturbances are electively bound to the tumour cells, only some normal tissues may secondarily be injured. A rapid and intensive lysosomal activity in all the tumour cells may probably be of importance in the reaction.


Malignant tumours of the nasopharynx.

Malignant tumours of the nasopharynx. A series of 115 patients with malignant tumours of the nasopharynx were primarily irradiated. All the cases of carcinoma were TNM classified in retrospect. 60Co irradiation appeared to afford a somewhat better prognosis than conventional irradiation previously used. The 5-year crude survival rate for the patients with lymphoma and with carcinoma was 40.0 per cent and 23.8 per cent respectively. A distinctly better prognosis was found for women than for men and the prognosis was independent of whether or not lymph node metastases were present. There seems to be no indication for maintaining lympho-epithelial carcinoma as a special group of tumour. Surgical procedures are rarely indicated in the treatment of malignant nasopharyngeal tumours.


Radiation hygiene in photofluorography.

Radiation hygiene in photofluorography. This paper comprises measurements and experiences from the surveillance of 36 photofluorographic units in Norway. Measured patient doses are given. Practical means for reducing the doses are emphasized. The radiation hygiene for the personnel in mass chest surveys is discussed.


Automated thermoluminescence reader. I. Technical construction and function. An automated TLD reader has been developed and constructed. The dosimeter material consisting of LiF is permanently enclosed in thin-walled teflon tubes. Dosimeters are identified by numbers, which simplifies individual calibration. A calibration radiation source consisting of a cylinder (90Sr-90Y) is used for the calibrations. The function of the reader and the calibration radiation source is described, and the method of measurement briefly reported.


Radiation-induced lesions of the brachial plexus correlated to the dose-time-fraction schedule. Radiation induced brachial plexus lesions were correlated to the dose-time-fraction schedule. Ellis' formula was used and the mathematical treatments were made according to KIRK et coll. (1971). It was found that the frequency of lesions increases very rapidly for small increases of CRE over a certain level.


Dosimetry of combined intracavitary and external irradiation of carcinoma of the uterine cervix. Dose distribution around intracavitary applicators (Stockholm technique) has been investigated. The gradient of dose around the combination of intrauterine and vaginal applicators used is steep. The position of the uterus with and without the radium applicators inserted varies. Together with the steep dose gradient this implies that external irradiation following intracavitary treatment involves a risk for overdosage to tissues in the vicinity of the uterus and underdosage to the parametrium.


Objective symmetry detector method for gammaencephalography. III. Diagnosis of abnormal 99TcmO4 distribution in the skull. The objective classification of results of the previously described symmetry detector method for gamma encephalography is reported. The different evaluation parameters were chosen after comparing their detectability in different subregions of the head or as a result of findings in certain patients. The detectability was estimated from the results of phantom measurements related to the normal ranges of evaluation parameters. The borders of the classification criterion are discussed in relation to the number of evaluation parameters used.


Dual photon absorptiometry in lumbar vertebrae. II. Precision and reproducibility. Bone mineral content in lumbar vertebrae is determined by the attenuation of 59.6 keV (241Am) and 662 keV (137Cs) photons using the intermittent scanning technique. The precision, mainly influenced by decay variations, is analyzed mathematically. The reproducibility in patient measurements is also affected by variations in positioning, movements during measurement and base line errors. In four normal subjects the reproducibility ranged from 3.4 to 5.7%. The long-term stability was better than 1% during a five-month period as tested by phantom measurements.


Clare-Bishop area in the cat: location and retinotopical projection. Visual responses of single units in the cortex of the middle suprasylvian sulcus were evaluated in the pretrigeminal cat. Electrode penetrations which passed through the Clare-Bishop area were in 94 percent of the cases within the stereotaxic coordinates A2 and A8. Within the Clare-Bishop area 40 percent of the units were responsive to the visual stimuli employed whereas adjacent to it only 10-20 percent responded. Correlation between receptive field size and eccentricity was poor or absent. Most receptive field centers lay within the lower contralateral quadrant. Because of the large size of the receptive fields, their scatter and individual variability, it was not possible to depict a precise scheme of retinotopical projection.


Visual responses of neurons in the Clare-Bishop area of the cat. Single unit responses in the Clare-Bishop area of the pretrigeminal cat were analyzed using stationary and moving visual stimuli. Of the units responding, 80 percent could be influenced by a 0.5 s diffuse flash, most displaying inhibition or excitation to both "on" and "off". In most units responses to stationary shapes were not very specific. Responses to moving stimuli were strong and directional preference was usually present. For the majority of cells the optimal speed of movement was in the range from 100 to 800 deg/s, and some cells preserved their direction preferences when the speed was over 1,500 deg/s. The direction preference could be reversed depending on the speed of movement, location in the receptive field or the shape of stimulus.


Response of cat cerebellar vermis induced by sound. I. Influence of drugs on responses of single units. Experiments were done on the cats under Chloralose and/or Nembutal anesthesia. A click was used as a standard acoustic stimulus. The type of responses of single units from cerebellar vermis lobuli V-VII were analyzed. At least four different types of single unit reactions were observed and one of these - oscillatory - was produced by the presence of Flaxedil simultaneously with Chloralose. The system that controls the activity of the middle-ear-muscles can be suspected as the source of the oscillatory pattern of the cerebellar response. Latencies were found to be constant, independent of anesthesia, but it was necessary to have a low level of Nembutal anesthesia because of the overriding inhibitory influence of Nembutal.


Effects of hyperthermia and stimulation of the hypothalamus on the activity of the phrenic nerve in hypo- normo- and hypercapnic rabbits. Experiments were carried out on male rabbits, anesthetized with urethane, bilaterally vagotomized, paralysed and artificially ventilated. The preoptic area (POA) was stimulated at three different levels of CO2: in hypo- normo- and hypercapnia under normothermia, moderate hyperthermia and hyperthermia. Changes in central respiratory activity (monitored by phrenic nerve activity) due to CO2 levels, stimulation of the POA during normothermia and progressively increased body temperature were investigated. Results showed that: (i) When body temperature was raised and during stimulation of the POA, the frequency of phrenic nerve volleys, tidal volume eq. and minute ventilation eq. were increased. (ii). The acceleration of the respiratory rhythm was reached by shortening of both respiratory phases, inspiratory and expiratory. However, the expiratory phase changed more than the inspiratory one and there was a close proportional relationship between inspiratory and expiratory durations. (iii) Together with the increase in the respiratory drive resulting in the combination of influences of both factors, the temperature and CO2, the effects of POA stimulation diminished gradually.


Stimulus controllability and the latent inhibition effect. The effects of stimulus controllability on latent inhibition was examined in instrumental and classical conditioning. Rats allowed control over stimulus termination prior to avoidance conditioning exhibited no retardation of avoidance learning whereas subjects yoked to these rats with respect to pattern and amount of stimulus exposure but given no control over stimulus termination were retarded. However, groups of rats differentiated only by control over stimulus termination, prior to classical conditioning, were equally and severely retarded in the acquisition of a classically conditioned response as indexed by the CER technique. The results were discussed in terms of a learning hypothesis of latent inhibition.


Comparison of the septal lesion effects on visual and spatial discriminations in rats. Postoperative performance in acquisition and reversal learning of septal rats was investigated and compared with control rats in three experiments. Experiment I involved a simultaneous black-white discrimination task. The number of errors in normal and septal rats was similar in acquisition and reversal learning. Both septal and normal rats manifested directional response sets. Experiment II examined a position habit discrimination. Acquisition was similar in septal and normal rats, while reversal learning was impaired in septal rats. Experiment III, which investigated a position habit discrimination with available irrelevant visual stimuli indicated that both acquisition and reversal learning were impaired in operated animals. Results suggested that septal rats utilize response produced cues to control their behavior, but the enhanced orienting response to the visual stimuli interferes with the proprioceptive stimuli.


Ethological studies in the ant Tetramorium caespitum Mayr. I. Foraging and building behavior. Carrying heavy objects is a common element in the foraging and building behavior of ants. The initial stages of this behavior, i.e., lifting and moving in T. caespitum displayed as stereotyped patterns of movement. These patterns do not improve as the ants become older and more experienced, which suggest their congenital nature. Growing experience of ants is manifested in the later stages of the transportation of heavy objects, and especially in entering the correct opening of the nest with the carried prey. When a foraging ant leaves its nest to return to the prey it initially moves in the general direction of its objective. It is not until a certain distance from the nest is reached, that the ant is able to use olfactory stimuli to locate and follow its previous path. These observations indicate that the representatives of this species do not learn an exact way to and from the nest but instead have a memory for direction. The congenital character of these basic elements of foraging and building behavior allows the existence of a social organization without a division of work and foraging areas.


Ethological studies in the ant Tetramorium caespitum Mayr. II. Interspecific relationships. The structure of relationships between the neighboring species of ants is characterized by great variability. What happens when particular individuals meet - depends upon considerable differences between individual behaviors of ants and a number of variable factors determining the actual emotional state of the workers. From these factors, it is the general structure of forces between the nests that changes slowest, and may be responsible for reaching temporary stabilization of the interspecific relationships. Invariable hierarchical structure between the species occurs very rarely: when there is an enormous supremacy of one of the species.


Metal plate fixation after anterior fusion of unstable fracture dislocations of the cervical spine. Unstable fracture dislocations due to torn ligaments, fractures of both articular processes, or detachments of entire vertebral arches from vertebral bodies still pose the problem of fixation after anterior fusion. The application of internal metal plate fixation--using the small AO (ASFI) fragment equipment--is described in 3 cases, and the advantages of this type of fixation are discussed.


Myelotomography in the diagnosis of lumbo-sacral disc prolapse. Myelotomography is of considerable help in the preoperative diagnosis of lumbo-sacral intervertebral disc prolapses. Contrast views and new water-soluble media make the technique very useful. On the basis of 550 myelographies, indications for myelotomography are discussed. The examination should be performed in patients with clear clinical symptoms of intervertebral disc prolapse but negative routine myelograms. The introduction of myelotomography has reduced the incidence of false negative preoperative radiological investigations.


Experience with homologous lyophilised nerve grafts in the treatment of peripheral nerve injuries. Report of a series of 18 late secondary nerve grafts using lyophilised (disantigenised and disenzymatised) homografts of the Braun Melsungen Company. In contrast to the publication of Kuhlendahl et al. (1972) 32% of the cases showed definitive signs of regeneration. Therefore, in spite of the fact that autografts give better results, further research into the possibilities of homografts seems desirable. Their potential usefulness obviously is restricted to cases in which from any reasons autologous nerve grafts are not available.


The relation between intracrainal pressure, mean arterial pressure and cerebral blood flow in patients with severe head injury. In patients with severe head injuries ICP, MAP and CBF were measured continuously. In most patients there was a positive vasopressor response to increasing ICP, but the ICP/MAP ratio varied considerably in individual cases. CBF was diminished either by increasing ICP or by decreasing MAP. This effect was more marked with ICP above 40 mm Hg or MAP below 110 mm Hg. In terminal stages there was often a negative MAP/ICP ratio accompanied by massive cerebral hyperaemia. Key words: Severe head injury--intracranial pressure--mean arterial pressure--cerebral blood flow--cerebral perfusion pressure--critical limit of ICP and CBF. ICP equals intracranial pressure (mm Hg); CBF, Flow equals cerebral blood flow (ml/min); MAP equals mean arterial pressure (mm Hg); CPP equals cerebral perfusion pressure (mm Hg) (difference between MAP and ICP); BP equals blood pressure.


[The use of the "anti-G-suit" during operations in the sitting position as a treatment of postural hypotension.(author's transl)]. The use of the "Anti-G-Suit" in patients with postural hypotension is described. Acute falls in the blood pressure during operations in the sitting position can be successfully treated with the aid of an external counterpressure garment reaching from ankles to xiphoid process. The mean increase in systolic blood pressure was about 60% in hypotensive and 17% in normotensive control patients. A reciprocal relation between pre-treatment blood pressure and its increase after use of the "G-Suit" was noticed. In contrast to previous practice, we were able to operate on all hypotensive patients in poor condition. The effect of external counterpressure on the lower part of the body can be explained by increase of peripheral resistance and decrease of vascular flow, resulting in better venous return, displacement of the circulating blood above the diaphragm and augmentation of systolic blood pressure.


Partially resected and irradiated cerebellar astrocytoma of childhood: malignant evolution after 28 years. Partial resection of a cystic cerebellar astrocytoma with well-differentiated histomorphology in a 13 year old girl was followed by a course of X-ray therapy. After a period of 27 years symptoms recurred. The patient died 2 days after a second operation, and autopsy showed a large partly cystic cerebellar astrocytoma with distinct morphological evidence of malignancy in some areas. The role of the X-ray therapy in the formation of peculiar bizarre giant cells in our case is discussed. Radio-induction of malignant tumour evolution after long latency has to be considered, but the possibility seems remote. However, the value of radiotherapy for cystic cerebellar astrocytomas needs some reconsideration. More caution in the long term prognosis of cystic cerebellar astrocytomas of childhood might be appropriate.


Radioisotope cisternography in head-injured patients. Of 600 patients submitted to radioisotope cisternography carried out with radioiodinated human serum albumin (I131-HSA) a group of 140 had head injuries. Our investigation was intended to study the modifications of CSF circulation and absorption which accompany cranio-cerebral trauma. Of 88 head injured patients who did not undergo operation 44 had transient loss of consciouness, and 44 were in prolonged coma. Fifty-two patients underwent operation. Of these 5 had skull fractures with dural lesions, 7 had extradural haematomas, 19 had subdural haematomas, and 21 had brain contusions. Cisternograms were performed at different time intervals after trauma, and in some instances the test was repeated in order to study the possible long tern alterations of CSF circulation and absorption. Abnormalities of cisternographic pictures are classified into the following groups: 1 degree asymmetric diffusion; 2 degree operative cavity stagnation; 3 degree ventricular reflux; 4 degree associated abnormalities. Cisternographic features are analysed in relation to the corresponding clinical and pneumoencephalographic patterns in the patients examined. These investigations may enable us to recognise possible indications for shunt procedures in the management of CSF absorption defects, which are so frequently apparent after head injury.


Experiences with intraluminal occlusion with the Fogarty catheter in the treatment of carotid-cavernous sinus fistulas and other lesions at the base of the skull. Indications for the occlusion of the extradural portions of the carotid and vertebral arteries with the Fogarty catheter are demonstrated in 5 cases of traumatic carotid-cavernous sinus fistulas, in 1 case of an extradural carotid aneurysm originating from the anterior portion of the carotid siphon, in 1 case of traumatic carotid-jugular vein fistula and vertebral artery aneurysm with a-v shunt at the level of the atlas, and in 2 cases of large tumours of the base of the skull extending into the cavernous sinus. The limitation of the method is shown in one case where the catheter could not be passed through a "high" kink of the carotid artery. "Low" kinking, at the typical site above the bifurcation, can be overcome by mobilization and stretching of the vessel while introducing the catheter.


Experiences with radically operated acoustic tumours. A series of one hundred acoustic tumours submitted to radical operation is reviewed. The authors emphasize the possibilities of early correct diagnosis without contrast studies, draw attention to variations in nature and site of the tumour, and evaluate preservation of the facial nerve.


[Early and late results after coating intracranial aneurysms with biobond (author's transl)]. Fifteen patients with intracranial aneurysms have been treated by coating the aneurysms with Biobond. Three patients died in the postoperative period. Only one patient had recurrent haemorrhage one year after operation. In this case the sac had not been wrapped completely at operation. Histological examination of this aneurysm revealed macrophage reaction and signs of slow disappearance of the plastic. Ten patients, who were followed up for a period of 3 to 8 years after operation, had no recurrent haemorrhage and were in good clinical condition, 8 of them doing full-time work. No complications caused by the material have been encountered. In 5 patients carotid angiography was performed after operation. In 2 cases the size of the aneurysm was diminished and in 3 cases was unchanged. There were no signs of thrombosis or narrowing of the adjacent arteries. We believe that Biobond is suitable for coating intracranial aneurysms that cannot be treated by clipping or ligature. As Biobond in vivo seems partially to disappear after long periods, it should be applied in thick layers.